Psychosis Flashcards
definition of psychosis
Qualitatively different from normal experience
Involve inability to distinguish between subjective experience and reality
Characterised by lack of insight
Ddx of psychotic symptoms
Schizophrenia Psychoactive Substance Use Mania Depression Schizoaffective Disorder Delirium Dementia Other organic cause
what are self-referential experiences
The belief that external events are related to oneself
e.g. TV is transmitting messages to me
what do you need be aware of in regards to drug induced psychosis
comorbidity of substance use and schizophrenia & bipolar disorder
- more likely to misuse illicit drugs more than the general population
what does the presence of psychosis in depression show
severity of depression
i.e. very severe
what psychotic Sx are seen in depression
Delusions of worthlessness / guilt / hypochondriasis / poverty
Hallucinations of accusing / insulting / threatening voices – typically 2nd person
what are psychotic Sx in depression almost always
mood congruent content of psychotic Sx
what psychotic Sx are seen in mania with psychosis
Delusions of grandeur / special ability / persecution / religiosity
Hallucinations: auditory (e.g. God’s voice)
Flight of ideas
what is schizoaffective disorder
Schizophrenia + bipolar disorder
what is characteristic of Schizoaffective disorder
presence of both Sx typical of schizophrenia and affect disorder
= episodes either schizo-manic or schizo-depressed
what is delirium
Acute confusion with transient global disturbance
what needs to be consider in delirium as well
alcohol withdrawal, infection, medical / surgical in-patients, septicaemia, organ failure. hypoglycaemia, post-op hypoxia, post-ictal, encephalitis, space occupying lesion, drug intoxication or withdrawal
what are Sx of delirium
Clouding of consciousness
- ranges from subtle drowsiness to unresponsive
- disorientation in time, place & person
- fluctuating severity over time (lucid intervals)
- worse at night
impaired concentration/memory
- esp for new information
- visual hallucinations / illusions ± auditory hallucinations (often threatening)
- persecutory delusions
- psychomotor disturbance;
agitation or retardation - irritability
- insomnia
what do dopamine receptor subtypes do (D1 and D2)
D1 receptor family (D1 & D5):
- stimulate cAMP
D2 receptor family (D2,D3,D4):
- inhibit Adenylyl Cyclase
- inhibit voltage-activated Ca2+ channels
- open K+ channels
through what receptor family do typical (1st Gen) antipsychotics work
D2 inhibition
why are atypical (2nd Gen) antipsychotics preferred
less likely to induce extra-pyramidal side effects
Better efficacy against negative symptoms
Effective in patients unresponsive to typical drugs
what are extra-pyramidal side effects
acute dystonic reaction
parkinsonism
akathisia
dyskinesia
how does acute dystonic reaction present
Usually painful
Usually distressing
Very easily treated with anticholinergics
Develops quickly
what are features of parkinsonism caused by anti-psychotic
Drug-induced symptoms Tremor Rigidity Festinating gait If you need the drug and cant stop it, add in anticholinergic Develops over a few days
what are features of akathisia
Restlessness
Particularly in the legs
Need to move leg to get rid of the itch e.g.
Might find people to walk a lot, or walk on the spot
Constantly moving, uncomfortable if sit still
Difficult to treat, unless reduce antipsychotic
Develops over a few days
what are features of dyskinesia
Abnormal involuntary movement
Typically oral or peri-oral i.e. Lips, tongue
Typically on the move
Not often recognized by the individual – usually other people the notice it
Very hard to treat, and once it is developed it continues to develop/get worse when you remove the antipsychotic
Slow, delayed
Doesn’t happen for year
what is metabolic syndrome
abdominal (central) obesity elevated blood pressure elevated fasting plasma glucose high serum triglycerides low HDL levels
anti-psychotics block histamine receptors = what Sx does this cause
sedation
increased appetite
anti-psychotics block alpha-adrenergic receptors = what Sx does this cause
postural hypotension
what are the difference in side effects of atypical and typical anti-psychotics
typical - more motor
atypical - more metabolic
blockade of what receptor causes extra pyramidal side effects and what other Sx do you get when this is affected
D2 blockade
Hyperprolactinaemia
what should you do if a patient on clozapine has a sore throat
FBC
how is clozapine monitored
Weekly for the first six months
Fortnightly for the next six months
Every four weeks thereafter
For one month after cessation of clozapine
